Journal article
Clostridium difficile exposure as an insidious source of infection in healthcare settings: an epidemiological model
BMC Infectious Diseases, Vol.13(1)
2013
Abstract
Background: Clostridium difficile is the leading cause of infectious diarrhea in hospitalized patients. Its epidemiology has shifted in recent years from almost exclusively infecting elderly patients in whom the gut microbiota has been disturbed by antimicrobials, to now also infecting individuals of all age groups with no recent antimicrobial use.Methods: A stochastic mathematical model was constructed to simulate the modern epidemiology of C. difficile in a healthcare setting, and, to compare the efficacies of interventions.Results: Both the rate of colonization and the incidence of symptomatic disease in hospital inpatients were insensitive to antimicrobial stewardship and to the prescription of probiotics to expedite healthy gut microbiota recovery, suggesting these to be ineffective interventions to limit transmission. Comparatively, improving hygiene and sanitation and reducing average length of stay more effectively reduced infection rates. Although the majority of new colonization events are a result of within-hospital ward exposure, simulations demonstrate the importance of imported cases with new admissions.Conclusions: By analyzing a wide range of screening sensitivities, we identify a previously ignored source of pathogen importation: although capturing all asymptomatic as well as symptomatic introductions, individuals who are exposed but not yet colonized will be missed by even a perfectly sensitive screen on admission. Empirical studies to measure the duration of this latent period of infection will be critical to assessing C. difficile control strategies. Moreover, identifying the extent to which the exposed category of individual contributes to pathogen importation should be explicitly considered for all infections relevant to healthcare settings.
Details
- Title
- Clostridium difficile exposure as an insidious source of infection in healthcare settings: an epidemiological model
- Authors/Creators
- L. Yakob (Author/Creator) - The University of QueenslandT.V. Riley (Author/Creator) - The University of Western AustraliaD.L. Paterson (Author/Creator) - The University of QueenslandA.C.A. Clements (Author/Creator) - The University of Queensland
- Publication Details
- BMC Infectious Diseases, Vol.13(1)
- Publisher
- BioMed Central
- Identifiers
- 991005545222507891
- Copyright
- © 2013 Yakob et al.;
- Murdoch Affiliation
- Murdoch University
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.120 Inflammatory Bowel Diseases & Infections
- 1.120.1133 Clostridium Infections
- Web Of Science research areas
- Infectious Diseases
- ESI research areas
- Immunology